Healthcare Provider Details

I. General information

NPI: 1528689684
Provider Name (Legal Business Name): DON'T GO TO PRISON INITIATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 RALPH DAVID ABERNATHY BLVD SW
ATLANTA GA
30312-2482
US

IV. Provider business mailing address

1016 HOWELL MILL RD NW APT 3407
ATLANTA GA
30318-5588
US

V. Phone/Fax

Practice location:
  • Phone: 404-721-5080
  • Fax:
Mailing address:
  • Phone: 404-721-5080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMED LUWEMBA
Title or Position: CEO
Credential: JD
Phone: 404-721-5080